Doctor and the Medics


I first decided to train as a doctor about midway through my PhD. I had begun to think that a lifetime in the lab was not for me, and if I were to continue in research at all, I imagined it would be in a clinical setting.

Before applying for medical school places, I spent a week shadowing a junior doctor at Alder Hey Children's Hospital in Liverpool. I would strongly advise anyone considering medical training as a graduate to get some experience in a hospital or with a GP. You can get an idea of the stresses and strains of the job by following a doctor around for a few days. It also looks more convincing when you apply if you have made the effort to get into a hospital. I recently sat on a panel interviewing graduates for entry to the medical school here in Oxford, and those candidates who hadn't had any hospital experience were at a disadvantage. Most had.

Would-be graduate medics face a number of difficulties. The first is getting a place. Although the General Medical Council is in favour of increased recruitment of graduates into medicine, the number of places available is relatively small, though growing.

I managed to get a preclinical course place at Oxford, starting in October '96, with a scholarship attached. This was fortunate, as funding can be a problem. Local authorities have no statutory obligation to help with the funding of second (or third) degrees. Consequently, only the most generous authorities make any contribution, and often the graduate medic must look elsewhere for funds. For the clinical course, I have been helped by a scholarship from the Foulkes Foundation, which gives funding to help postdoctoral students to get a medical qualification. There are a number of charitable bodies who will help. Medical schools often have lists of these, or you can look in the Directory of Grant Making Trusts, which you can find in libraries.

However, anyone training as a doctor should expect to run up a large personal debt. I expect mine to be over £10,000, a combination of student and bank loans. This sounds daunting, but short of doing something stupid, you are pretty much guaranteed a job when you qualify. And the starting salary is good, approximately £22,000 for a job within the "new deal for House Officers." But the level of debt does mean that you should be pretty sure that medicine is for you before you start, or cut your losses early on if you discover it isn't, otherwise your debts will lock you in.

Your choice of medical school is an important one. Although many medical schools in Britain reduce the annual fees payable by self-funding students to around £1000, Oxford included, the Oxford colleges charge a further fee of around £1600-1900 pa. Graduates who might find funding a problem would be wise to shop around, both for the medical school with the lowest fees, and for the lowest cost of living around the school and the teaching hospital.

My course was a traditional preclinical one and, although there were other graduates, the bulk of the cohort were school leavers. This presented challenges, both academically and socially. The mass of material that must be absorbed during a preclinical medicine course, coupled with the unsophisticated heads that are absorbing it, leaves little room for subtlety. Coming from a research background, and having completed my doctoral thesis just weeks before starting the course, I found the level at which the majority of the material was pitched to be so rudimentary as to be depressing. Although initially I treated each essay as a challenge, and went to research papers to construct arguments, I found myself drowning under the weight of work, and ended up by using the same standard texts as the other hundred people in my year.

Socially, I was very lucky that my college, St Anne's, enrolled me as a graduate. Consequently, although I spent the days with people far younger than myself, I lived in graduate accommodation, so that the people I lived with were closer to my age and outlook. Other graduates were not so lucky, and ended up living with fresh-faced first years. Everyone likes to live the undergraduate life once, but it can get tiring the second time around.

After 2 years of the preclinical course, which covered the basic science areas of physiology, biochemistry, anatomy, immunology, and pathology, we moved on to the clinical course, which is hospital based. It was at this point that I realised that I had done the right thing. Spending the majority of your time in the hospital, you know quickly whether it is for you or not. Clinical medicine training is an apprenticeship. You learn by following the clinicians around and observing how they deal with different situations. As you become more confident and accomplished, you can deal with those situations yourself. The good thing about this way of learning is that you can go at your own pace, and deal with the knowledge base to your own level, which is very liberating.

In a little over 3 months I will begin my houseman year. Although I feel slightly anxious, I am looking forward to the challenge of doing the job. I hope that, being a little older and more experienced than my colleagues, the stresses of the year will faze me less--that certainly seems to have been the case during training. I have been fortunate that I have been able to keep my "research hand" in during the past 5 years, spending odd hours in the lab and getting a publication or two. In the future I aim to find myself a niche that allows me to do some research as well as seeing patients.

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